About Cognitive Behaviour Therapy (CBT)

All Changeways Clinic psychologists have studied and practiced extensively in the area of evidence-based psychotherapy. Most of the work involves a cognitive behaviour therapy approach.

What is Cognitive Behaviour Therapy?

Cognitive behaviour therapy, or CBT, has been researched more thoroughly than any other form of psychotherapy, and has been demonstrated to be effective for individuals experiencing a wide variety of difficulties.

CBT emphasizes the roles of thoughts and actions in life problems. On the behavioural side, CBT typically involves identifying specific activities likely to be helpful in overcoming a problem. Sometimes this involves specific lifestyle changes, such as physical exercise, sleep scheduling, dietary management, and goal-setting. Sometimes it involves training and practice in specific skills, such as assertiveness or physical relaxation. Sometimes it involves gradually overcoming the avoidance of feared situations.

The thinking side of CBT involves identifying thoughts that may be linked to the difficulty being experienced. Becoming aware of these thoughts (which are often automatic and outside awareness) allows them to be evaluated for their truth and/or usefulness. This lets the person consider other ways of thinking or understanding the situation that may be more helpful.

What about the role of emotions, or physical factors, or my life situation, or my history?

People sometimes wonder if other aspects of their lives will be ignored, given CBT's emphasis on thoughts and actions. In fact, CBT places emphasis on each of these areas.

Emotion. Many difficulties, such as depression or the anxiety disorders, are defined by the presence of distressing emotion. CBT suggests that much of our emotional experience comes from the way that we understand events. For example, our interpretation of the meaning of a rise in heart rate ("Is this normal or is it a sign of an impending heart attack?") will do much to determine our emotional reaction. As well, distress often results from our rejection of emotional experience ("The fact that I'm anxious means that I am an inadequate person"). Examining and altering our interpretations, and gradually approaching situations that we needlessly fear, can be enormously helpful in working with emotional difficulties. Far from closing down our emotions, the goal is often to open up to the full range of our emotional lives.

Physical factors. Physical illness, pain, nutritional deficiencies, and injuries or disabilities can all have a profound effect on our mood and our lives. The behavioural aspects of CBT are often designed to address these issues directly -- for example, by helping with an exercise plan, examining diet, and so on. As well, CBT can be used in conjunction with other physical approaches such as medication. Many people with depression, for example, benefit from a combination of medication (to assist with the physiological side of the problem) and therapy (to help improve lifestyle, deal with the causes of the problem, and address negative thinking).

Life situation. Difficult life events can have a major impact on our mood and our ability to cope. Minor hassles can also build up and become overwhelming. CBT emphasizes strategies to work on difficult life situations and gradually overcome hassles, as well as to identify ways of thinking about these situations that are more helpful.

History. No problem appears all on its own. Our life history can profoundly influence our vulnerability to a variety of psychological difficulties. Understanding historical influences -- and, importantly, how they play out in the present -- can be enormously helpful in making the best use of our strengths and moderating the negative influences of past trauma and difficulty.

What’s my role?

In CBT, there is no assumption that listening to your therapist for an hour will produce a magic cure for any problem. The emphasis is on a joint problem-solving effort in which you work with your therapist to identify exercises and strategies for you to carry out in your real life, outside the consulting room.

So it's best not to think of CBT as a commitment of an hour a week (or whatever schedule you agree upon with your therapist). Instead, change must be a major priority in your life -- both during the consulting hour and in the time between appointments. In a way, your therapist is not really the therapist in CBT. You are the therapist.

How long does therapy last?

This depends on your own wishes, the type of difficulty you are working on, the amount of work you are willing or able to do between sessions, and so on. Generally, CBT is designed to be a brief therapy approach. The usual range is 6 to 25 sessions for difficulties such as depression or anxiety disorders. This issue should be discussed with your therapist.

I have limited insurance coverage. Can therapy be sped up?

Sometimes therapy can be accelerated, if you are able to make it a priority in your life. Sessions can also be spread out (every two or three weeks, for example) to make the most of the coverage you have. We will work with you to plan a course of therapy that meets your needs.